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Analysis of three-chamber view conventional and tagged cine MRI in patients with suspected hypertrophic cardiomyopathy

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To investigate the potential value of adding a tagged three-chamber (3Ch) cine to clinical hypertrophic cardiomyopathy (HCM) magnetic resonance imaging (MRI) protocols, including to help distinguish HCM patients with regionally impaired cardiac function.


Forty-eight HCM patients, five patients with “septal knuckle” (SK), and 20 healthy volunteers underwent MRI at 1.5T; a tagged 3Ch cine was added to the protocol. Regional strain, myocardial wall thickness, and mitral valve leaflet lengths were measured in the 3Ch view.


In HCM, we found a reduced tangential strain with decreased diastolic relaxation in both hypertrophied (p = 0.003) and remote segments (p = 0.035). Strain in the basal septum correlated with the length of the coaptation zone + residual leaflet (r = 0.48, p < 0.001). In the basal free wall, patients with SK had faster relaxation compared to HCM patients with septal hypertrophy.


The 3Ch tagged MRI sequence provides useful information for the examination of suspected HCM patients, with minimal additional time cost. Local wall function is closely associated with morphological changes of the mitral apparatus measured in the same plane and may provide insights into mechanisms of obstruction. The additional strain information may be helpful when analyzing local myocardial wall motion patterns in the presence of SK.

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Three-chamber view


Anterior mitral leaflet


Cardiovascular magnetic resonance imaging


Coaptation zone




Ejection fraction




Hypertrophic cardiomyopathy


Left atrium


Left ventricle


Left ventricular outflow tract


Magnetic resonance imaging


Mitral valve


Greatest principal strain


Least principal strain


Posterior mitral leaflet


Residual leaflet


Systolic anterior motion


Standard deviation


Septal knuckle


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This work was partially funded by NIH (NIH R21-EB109595 and R01 HL127661).

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Authors and Affiliations



TC developed the analysis pipeline, performed the data analysis, interpreted the data and wrote the manuscript. MK participated in and drafting of the manuscript and results interpretation. LA designed the study, interpreted the data and edited the manuscript. DH and MS performed the clinical analysis and interpreted the data. LT and AH wrote the motion estimation algorithm and contributed to the analysis algorithms. All authors read and approved the final manuscript.

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Correspondence to Teodora Chitiboi.

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All subjects were retrospectively studied under a research protocol approved by the local Institutional Review Board (IRB).

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Chitiboi, T., Kanski, M., Tautz, L. et al. Analysis of three-chamber view conventional and tagged cine MRI in patients with suspected hypertrophic cardiomyopathy. Magn Reson Mater Phy 33, 613–626 (2020).

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